| Doctor Name: | THEODORE R DEROCHE |
| NPI Number: | 1013036607 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | MH50 |
| Business Practice Address: | 2760 Se 17th Street Suite 300 Ocala, FL - 34471 |
| Business Phone Number: | 3526294113 |
| Business Fax Number: | 3864391403 |
| Mailing Address: | 701 North Central Ave, FLAGLER BEACH |
| State: | FL |
| Postal Code: | 32136 |
| Phone Number: | 3864391403 |
| Fax Number: | 3864391403 |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH50 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |